You can also request any materials on this website in another format, such as large print, braille, CD or in another language. A power elevation feature involves a dedicated motor and related electronics with or without variable speed programmability, which allows the leg rest to be raised and lowered independently of the recline and/or tilt of the seating system. Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Program Support Unit (PSU) staff are responsible for completingForm 4800-D, Fair Hearing Request Summary, to file the appeal through the Texas Integrated Eligibility Redesign System (TIERS) when an applicant/member requests a fair hearing. If the appealed action is a TW/MEPD financial denial, staff complete Form 4800-D and enter the name of the CRU supervisor as the agency representative. Except for Forms H2060 and 4800-D, Managed Care Organization (MCO) staff may develop their own forms unless the form instructions indicate otherwise. Texas STAR+PLUS Waiver Programs STAR+PLUS Waiver Programs Persons on the HCBS waivers CLASS, HCS, TxHML, DBMD and in ICF-IID facilities The individual care you want. date the CDS employer may begin incurring expenses to initiate start-up activities and to incur recruitment and hiring expenses; date the CDS employer may begin delivery of program services through the CDS employer's service providers; the number of units, the approved rate, or the amount authorized in the ISP for each service to be delivered through the CDS option; total funds authorized for each program service to be delivered through the CDS option; and. In the event the member does not provide his or her own furnishings, the facility must provide for each member: Furnishings provided by the ALF must be maintained in good repair. Case managers may assess these individuals for services if it appears services can be authorized and delivered prior to enrollment. a request to determine if service is already being delivered; and, have Supplemental Security Income (SSI) Medicaid or another full Medicaid program; or. Forward the intake request to the enrollment broker. The MCO discusses residential options with the member, allowing the member to choose his or her preference. Next, calculate the annual amount of units to be purchased through QIT by multiplying the monthly units by 12. The provider must deliver services as identified on the member's ISP attachments. applicant's or members Social Security number (SSN) and date of birth (DOB); members SSN and answer to a security question; members DOB and answer to a security question; or. During regular monitoring visits, the MCO RN service coordinator must contact the MCO management and MCO-contracted AFC provider agency, if applicable, if the AFC home provider is not meeting the member's needs or the home provider requires additional support or training to meet the members needs. Cognitive Rehabilitation Therapy (CRT) A service that assists an individual in learning or relearning cognitive skills that have been lost or altered as a result of damage to brain cells/chemistry in order to enable the individual to compensate for the lost cognitive functions. Call 844-867-2837 (TTY 711) to schedule a ride. Since oxygen is a flammable substance, precautions must be taken to ensure that smoking is prohibited in or around the area where the oxygen is being self-administered. a description of the specific and individualized assessed need that justifies the modification; a description of the positive interventions and supports that were tried but did not work; a description of less intrusive methods of meeting the need that were tried but did not work; a description of the condition that is directly proportionate to the specific assessed need; a description of routine collection and review of data to measure the ongoing effectiveness of the modification; the established time limits for periodic reviews to determine if the modification is still necessary or can be stopped; the members or legally authorized representatives signature showing evidence of informed consent to the modification; and. After 30 days, the application must be denied for failure to return the information needed to determine financial eligibility. See the Form 4800-D instructions for more specific directions for completion and transmittal. Nursing services purchased through the STAR+PLUS Home and Community Based Services (HCBS) program may not be provided in the following settings as defined in 42 Code of Federal Regulations (CFR), 441.530(a)(2): All STAR+PLUS Home and Community Based Services (HCBS) program members meet medical necessity (MN) and have a need for one or more nursing tasks, as described in the Texas Administrative Code (TAC), Title 40, 19.2401. The MCO service coordinator must contact the member to schedule an assessment for STAR+PLUS HCBS within 14 business days of notification by the MCO RS. The FMSA conducts payroll files and pays employer federal and state taxes on behalf of CDS employers, screens potential service providers for employment eligibility and provides ongoing support for members who choose the CDS option. Instead, there are a limited number of participant enrollment slots, and when these slots are full, an interest list (waiting list) for program participation forms. HMAs include performance of nursing tasks by a paid attendant and by informal support. These are indicated by an asterisk (*) below. A provider must offer at least one of the following activities monthly, at cost to the provider: members need an initial assessment for prior authorization by a STAR+PLUS MCO; members transfer to a new facility (conducted by the new facility); the DAHS nurse determines a member needs to be reassessed. Carbon monoxide detectors cannot be purchased under STAR+PLUS Home and Community Based Services (HCBS) program as a "fire safety adaptation and alarm.". UseForm H4800-A, Fair Hearing Request Summary (Addendum), to submit all supporting documentation to the fair hearings officer. Extended state plan services are services provided which exceed benefits allowed under the state plan. A member's copayment may change during the time he is receiving the STAR+PLUS Home and Community Based Services (HCBS) program, typically due to a change in income or medical expenses. help setting up a utility or telephone account; non-medical transportation, including mainline, special transit and local transportation providers; banking, bill payment and direct deposit. Be able to move to a community setting within 60 days after STS is authorized. Form H1700-1, completed for members in the community, is submitted to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. If left unattended, for instance, the member may wander outside, turn on electrical appliances and burn herself or himself, or try to walk and then fall. In-home respite care services is not intended to be used when the primary caregiver needs to be out of the house for short periods of time (for example, to go to the pharmacy or grocery store to pick up medications or grocery items). For example, a member would be able to continue to receive Family Care until the MCO authorizes personal attendant services (PAS). To be eligible for STAR+PLUS HCBS program PAS, the MCO must assess applicants in a face-to-face visit. The MCO must also ensure assisted living facility (ALF) and adult foster care (AFC) providers have processes in place to discuss with the member their preferences for their daily schedule and activities. CCSE staff must not authorize CCSE Title XX services for anyone receiving the STAR+PLUS HCBS program. If the copayment amount changes for any of the months the member has been notified of in advance, Form 1578 must be sent to reflect the new copayment amounts for each month. If MN for a pending upgrade is denied, the MCO must inform PSU staff withinthree business daysby uploading Form H2067-MC to MCOHub. If the adult foster care (AFC) home is the members home, the member must agree to have modifications made to the home. Disagreements on policy or legal issues may be submitted by program staff to the regional attorney. Texas Health and Human Services Commission (HHSC) and managed care organization (MCO) staff must send each member the Health and Human Services Agencies' Notice of Privacy Practices, upon certification. PAS includes assisting the member with the performance of activities of daily living (ADL) and household chores necessary to maintain the home in a clean, sanitary and safe environment. If the total amount of the items or services needed is more than the total amount authorized, the TAS agency must obtain prior approval and an updated Form 8604 from the MCO. Adult Foster Care Services personal care assistance and homemaker services in an adult foster care home I acknowledge I was able to review the Agreement to be Contacted, Terms of Use, and Privacy Policy. Within 14 days of release from the interest list (see3311.1, Interest List Procedures), Program Support Unit (PSU) staff take the following steps to ensure candidates are successfully enrolled in the STAR+PLUS Home and Community Based Services (HCBS) program. In such a case, the invoice or receipt should show the: Group purchases are only allowable if they can be traced to the member. The deliverables referenced in these chapters collect information about number of members authorized to receive Personal Care Services (PCS) and number of members who received those If the member chooses to self-direct designated services, the MCO coordinates delivery of non-member-directed designated services. Installation of heavy-duty shocks as required by a lift installation may be included as part of the vehicle modification. The AFC or AL participant will keep $85 a month for personal needs. TAS items may be placed in a home other than the applicants or member'sonly when furnishings are not available and are necessary for the applicant or member to transition to the community. For applicants or members residing in AFC or AL settings, the copayment amount is usually applied to the cost of AFC or AL first. PSU staff enters the remainder of the reassessment ISP period. The MCO calculates the type and amount of payment the applicant or member will make directly to the service provider using the following steps: If the available qualified income trust (QIT) copayment amount exceeds the daily rate for adult foster care (AFC) or assisted living (AL), the monthly AFC or AL copayment amount must be calculated using the exact number of days in each month (28, 30 or 31 days). The MCO service coordinator must emphasize that the applicant assumes all responsibility for arranging their self-directed services. Part One is general facts about UnitedHealthcare Community Plan STAR+PLUS. It may address one or more of the following: Facilitate independent transfers, uphill transfers and transfers across unequal seat heights to and from the wheelchair; and. person designated by law to make health care decisions when the member is in a hospital or nursing home and is incapacitated or mentally or physically incapable of communication. Reimbursement for the cost of co-insurance for the purchase or rental of adaptive aids or the purchase of medical supplies reimbursed by Medicare or private health insurance is available if the following conditions are met: Reimbursement for the co-insurance amount to Medicare or private health insurance for therapy services or the rental of any adaptive aids is a cost-effective way to utilize third-party resources (TPRs). The process is abbreviated since the member already has a: The gaining PSU coordinates all appropriate activities between the losing PSU, MCOs, member, Enrollment Resolution Services (ERS) and other key parties to help ensure a successful transition. Managed Care Compliance & Operations (MCCO) A unit within the Medicaid/Children's Health Insurance Program (CHIP) Division of HHSC that is responsible for administrative and operational aspects of administering the Medicaid managed care programs. The STAR+PLUS Home and Community Based Services (HCBS) program member must be encouraged to contact the managed care organization (MCO) to request any services being denied that are not included in the STAR+PLUS HCBS program individual service plan (ISP). We also offer additional services called Value Added Services (VAS). If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. When required by this section, supporting documentation for reimbursement of the services and deliverables will also be submitted. An NF resident discharged from the facility into a waiver program is eligible to receive up to $2,500 in TAS for assistance with setting up a household. Form H2065-D, Notification of Managed Care Program Services, must be mailed by Program Support Unit (PSU) staff withintwo business daysof eligibility determination advising the applicant or member of the date of eligibility for the STAR+PLUS Home and Community Based Services (HCBS) program service before the authorization of any services. The member may not live in an adult foster care (AFC) or assisted living (AL) setting.